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Modification of Longo procedure for high grade hemorrhoids with immediately reduction of the residual prolapse

Ersin Hodzhadzhikov, Ivan Semerdzhiev, Bozhidar Nametkov, Deyan Lazarov, Mihail Tabakov, Dimitar Andonov, Antonii Filipov



Hemorrhoidal disease is a common condition in humans, affecting between 4.4% and 36.4% of the general population and has been known for thousands of years. It was even described in Egyptian papyruses.

The most common symptoms are prolapse, bleeding, pain, pruritus, itching, and, in some cases, incontinence.

The hemorrhoid management algorithm depends mainly on the stage of the condition and the patient’s complaints. In early stages most patients just have to change their lifestyle and dietary habits. Some patients with grade I, II, and sometimes grade III hemorrhoids might need ligation, sclerotherapy, or coagulation with different devices. Surgical treatment in hemorrhoids is only needed in grade III and IV. The most popular technique, open hemorrhoidectomy, was described in 1937 by Milligan et al. Its main disadvantage is postoperative pain because of the presence of open wounds. In 1998 Longo proposed an innovative for its time technique that can deal with the postoperative pain. The problem with this procedure is the residual prolapse. 


The aim of this article is to present our experience with the Longo procedure for grade III and IV hemorrhoids with a modification of the technique in order to remove the postoperative residual prolapse.

Materials and Methods:

We present a retrospective study of 91 patients with grade III and IV hemorrhoids for a period of 1 year, between January 2021 and January 2022. All patients were operated on using a modification of the Longo procedure we present, performed by the same team. Standard parameters, like operative time, postoperative pain, hospital stay, residual prolapse, recurrence rate, and other perioperative complications were analyzed.


The mean operative time was 27 minutes. We used patient-controlled analgesia (PCA) in all patients and the percentage of additional postoperative pain killers was low. The mean hospital stay was 3 days. There was no residual prolapse detected immediately after the procedure.


With this modification we solve one of the biggest disadvantages of the Longo procedure—residual prolapse. This allows us to combine the advantages of open hemorrhoidectomy techniques and stapler hemorrhoidopexy, which leads to high satisfaction rate in patients.


modification, Longo operation, residual prolapse

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About The Authors

Ersin Hodzhadzhikov
Clinic of Endoscopic Surgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria

Ivan Semerdzhiev
Clinic of Endoscopic Surgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria

Bozhidar Nametkov
Clinic of Endoscopic Surgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria

Deyan Lazarov
Clinic of Endoscopic Surgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria

Mihail Tabakov
Clinic of Endoscopic Surgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria

Dimitar Andonov
Clinic of Endoscopic Surgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria

Antonii Filipov
Clinic of Endoscopic Surgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria

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